1: Hypertension

Question 1

Blood pressure classifications (normal, pre, stage I, stage II)

Answer 1

Normal is <80. Pre: 120-139/ 80-89. I: 140-159/ 90-99. II: 160+/100+

Question 2

Why is HTN not adequately controlled locally and nationally?

Answer 2

Many pt (access, knowledge, obesity, AE) and MD factors (time, knowledge of guidelines, white coat syndrome belief, time)

Question 3

How does treatment of HTN change for the elderly?

Answer 3

It shouldn’t. Managing shows significant decrease in death, HF, stroke

Question 4

Decreasing BP with exertion is a sign of ___

Answer 4

CAD

Question 5

Currently used HTN meds

Answer 5

Thiazide diuretics, beta-blockers, ACEI, ARB, Ca channel blockers

Question 6

Most effective HTN meds

Answer 6

All quite similar. At std dose: ARBs lower systolic ~10.3, BB 9.2, Ca and thiazides 8.8, ACEI 8.5

Question 7

A patient is on the standard dose of a BP med, but BP is still 145 systolic. Best next step?

Answer 7

Add another med. This is generally preferable to increasing dose as it will have a much greater effect.

Question 8

With combination therapy, which combination is best?

Answer 8

Generally no significant difference between combos

Question 9

Main benefits of lowering BP

Answer 9

Reduce incidence of: stroke (35-40%), MI (20-25%), HF (50%!!)

Question 10

African Americans are generally more sensitive to what BP med?

Answer 10

Ca channel blockers

Question 11

Patients with low renin or who are thin, older, or black would tip you more toward using which meds?

Answer 11

Thiazides, Ca channel blockers, alpha blockers

Question 12

Patients with high renin, younger, or overweight would tip you more toward using which meds?

Answer 12

BB, ACEI, ARB

Question 13

NNT for HTN to prevent a death over 2 years

Answer 13

40

Question 14

Which anti-hypertensive should not be used as monotherapy?

Answer 14

BB. Risk of stroke 16% higher than other drugs (though there’s no diff post MI)

Question 15

If patients want to treat HTN with lifestyle modifications, how long should you allow them to improve?

Answer 15

3-6 months

Question 16

What lifestyle factors can decrease BP? (5)

Answer 16

Dec: Na, alcohol, caffeine. Inc aerobic phys activity. Lose weight.

Question 17

Prevalence of HTN in US elderly 75+

Answer 17

78%

Question 18

Common causes of resistant HTN (4)

Answer 18

OSA, renal parenchymal disease, primary aldosteronism, renal artery stenosis

Question 19

Uncommon causes of resistant HTN (5)

Answer 19

Pheochromocytoma, Cushing’s disease, hyperparathyroidism, aortic coarctation, intracranial tumor

Question 20

What is Cushing’s Syndrome?

Answer 20

Pituitary gland -> inc adrenocorticotropic hormone (ACTH)/ glucocorticoid -> HTN. Caused by tumor or prolonged corticosteroid treatment.

Question 21

For age 1-10, what is an appropriate BP range?

Answer 21

age 1: 80-90/35-50

age 10: 90-110/50-60

Question 22

What percent of obese children have pre-HTN or HTN?

Answer 22

30%. Leads to end-organ damage & adult HTN

Question 23

Normal BP in children is

Answer 23

<90th percentile based on sex, age, height

Question 24

Pre-HTN in children is

Answer 24

90 to 95th percentile or greater than/ equal to 120/80. Rec lifestyle change

Question 25

Stage 1 HTN in children is

Answer 25

95 to <99th percentile + 5 mmHg based on sex, age, height. Lifestyle + possible med

Question 26

Stage 2 HTN in children is

Answer 26

> 99th percentile plus 5mmHg based on sex, age, height. Lifestyle + med management, screen for CV or renal disease

Question 27

What is the most common cause of secondary HTN? How does it present?

Answer 27

Renovascular HTN. Ischemic loss of renal fx, otherwise unexplained sudden onset pulm edema

Question 28

Presentation of hyperaldosteronism

Answer 28

HTN, hypoK+. Could have adrenal adenoma, bilateral adrenal hyperplasia

Question 29

Presentation of pheochromocytoma

Answer 29

Very rare. Episodic HA, sweating, tachycarida. 50% w paroxysmal HTN, 50% “essential”

Question 30

WIS prehypertension?

Answer 30

20% progresses to HTN per year. 27% inc in all cause mortality, 66% inc in CVD mortality.

Question 31

How prevalent is pre-HTN

Answer 31

31% in US

Question 32

Weight reduction can decrease BP by ROUGHLY how much per pound?

Answer 32

1 mmHg/pound

Question 33

What should you do with a patient with pre-HTN?

Answer 33

Counsel about lifestyle changes and monitor BP closely. Meds not indicated.